Elbows replaced in two hrs

Rare Surgery Helps 52-Yr-Old Get Over Rheumatoid Arthritis
Kounteya Sinha TNN
New Delhi: Fifty-two-year-old Savita Devi could hardly move her elbows. Red and swollen, the joints experienced excruciating pain, every time she tried to move it. After suffering for over four years, Savita Devi, a patient of acute rheumatoid arthritis, now tosses her granddaughter Roshni into the air with utmost ease. The pain has gone and so has the swelling and stiffness. She underwent a total elbow replacement surgery. Dr Naveen Talwar, orthopaedic surgeon at Sir Ganga Ram hospital, who has conducted seven such successful surgeries in the past eight months, says lack of awareness both among doctors and patients has been the cause for the surgery’s low prevalence. “Hips and knees are common weight-bearing joints and are more prone to arthritis. Patients are now aware of hips and knees being replaced. But those suffering from rheumatoid arthritis of the elbow or post-traumatic arthritis should know elbow replacement surgery is also being conducted in India,” Dr Talwar says. According to experts, at present only 2% of all arthroplasty (joint replacement surgeries) are that of the elbow. Rheumatoid arthritis at the elbow, however, accounts for 40% of all arthritis cases. Boasting of a good success rate, elbow replacement surgery lasts two hours and requires the patient to be in hospital for three days. “At the end of two weeks, the patient will be able to move his or her elbows at will and have no pain. The bioinert implants, made of either titanium or stainless steel, give the patient relief for at least 15 years and cause no reaction with the tissues,” he adds. Dr Subhasish Deb, orthopaedic surgeon from Kolkata, says, “Elbow replacement surgery is not very common in India. Till now, there weren’t many patients coming forward for it and so the number of doctors trained in this procedure was also low.” Senior orthopaedic surgeon Dr J P Manocha says, “An elbow joint replacement may also be used immediately following elbow fractures in elderly patients.” Elbow replacement arthroplasty restores functional mechanics to the joint by removing scar tissue, balancing muscles and inserting a joint replacement in place of the destroyed elbow. One part of the artificial joint is fixed to the inside of the humerus (arm bone) and the other part to the inside of the ulna (one of the forearm bones). The two parts are then connected using a hinge pin that gives the joint stability. As for the surgery, after anaesthesia, the surgeon makes an incision in the back of the elbow joint helping prevent damage because most of the blood vessels and nerves are on the inside of the elbow. The tendons and ligaments are then moved, exposing the joint. The joint surfaces of the ulna and the radius are removed with a surgical saw. The surgeon then prepares the hollow marrow of the ulna to hold the metal stem. He then repeats the procedure on the humerus.

(Source: TOI Mumbai, 24th sept Page 12)

Carb-rich diets ‘may damage liver’

Adiet rich in potatoes, white bread and white rice may be contributing to a “silent epidemic” of a dangerous liver condition. “High-glycaemic” foods—rapidly digested by the body—could be causing “fatty liver”, increasing the risk of serious illness. Boston-based researchers, writing in the journal Obesity, found mice fed starchy foods developed the disease. Those fed a similar quantity of other foods did not. One obesity expert said fatty liver in today’s children was “a tragedy of the future”. Fatty liver is exactly as it sounds - a build-up over time of fat deposits around the organ. At the time, no ill-effects are felt, but it has been linked with a higher risk of potentially fatal liver failure later in life. The study, carried out at Boston Children’s Hospital, looked at the effect of diets with precisely the same calorific content, but very different ingredients when measured using the glycaemic index (GI). This is a measure of how quickly the energy in the food is absorbed by the body, producing a rise in blood sugar levels—high GI foods lead to sharper rises in blood sugar, and similar rises in insulin levels, as the body releases the chemical in response. High GI foods include many breakfast cereals and processed foods such as white bread and white rice. Low GI foods include unprocessed fruit, nuts, pulses and grains, including rye or granary bread, spaghetti, apples and oranges. After six months on the diet, the mice weighed the same, but those on the high GI diet had twice the normal amount of fat in their bodies, blood and livers. The researchers say that because the processed carbohydrates are absorbed so quickly, they trigger the release of more of the chemical insulin, which tells the body to lay down more fat. Dr David Ludwig, who led the research, said that the results would also apply to humans, and even children, in whom fatty liver is becoming far more common. “This is a silent but dangerous epidemic,” he said. “Just as type 2 diabetes exploded into our consciousness in the 1990s, so we think fatty liver will in the coming decade.” Tam Fry, National Obesity Forum board member and chairman of the Child Growth Foundation, said it was clear that eating a diet rich in high-glycaemic food led to increased fat. He said: “Fatty liver is going to be one of the tragedies of the future unless we do something about it.” Azmina Govindja, a dietician and spokesman for the British Dietetic Association, said that the biggest threat from a diet rich in high-glycaemic food was development of insulin resistance—the first sign of type 2 diabetes. She said: “There is a place for high-glycaemic carbohydrates in moderation as part of a balanced diet, but there’s good research that eating too much can increase the risk of insulin resistance—and this can lead to serious health problems. AGENCIES